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Year 1 MBChB > GI > Flashcards

GI Flashcards

1
Q

What are the symptoms of Crohn’s?

A

Diarrhoea, abdominal pain, weight-loss

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2
Q

What GI region is affected by Crohn’s?

A

Entire GI tract (mouth to anus), particularly terminal ileum

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3
Q

What are the endoscopy findings in Crohn’s?

A

Inflamed, thickened mucosa, skip lesions

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4
Q

What are the histology findings in Crohn’s?

A

Inflammation extends beyond the submucosa and there ar granulomas seen

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5
Q

What investigations are done for IBD?

A

Inflamm markers, other bloods, stool cultures, AXR, sigmoidoscopy

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6
Q

What is the investigation of choice for a fistula in IBD?

A

CT

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7
Q

What is the management of Crohn’s?

A

steroids, immunosuppressants Biologics, Surgery limited and not curative – for obstruction abscess and fistulae

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8
Q

What is given for fistulation in Crohn’s?

A

Metronidazole

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9
Q

Is it oral or IV steroids if less than 6 stools per day?

A

Oral

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10
Q

What are the symptoms of UC?

A

Diarrhoea often bloody and mucousy, frequency linked to severity

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11
Q

Which GI region is affected in UC?

A

Colon only (Never beyond IC valve)

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12
Q

What are the endoscopy findings in UC?

A

Inflamed Mucosa, continuous lesions

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13
Q

What are the histology findings in UC?

A

Inflammation extends to the submucosa, crypt abscesses and reduced goblet cells

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14
Q

How is UC managed?

A

Mesalazine to induce remission (if not enough then add oral steroids - IV if greater than 6 stools)

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15
Q

What surgery is used in UC?

A

Curative with proctocolectomy and ileostomy or colectomy and J pouch (IA)

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16
Q

How is upper GI bleeding investigated?

A

Bloods, X match 4 units, endoscopy

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17
Q

What is the general management of upper GI bleeding?

A

ABCDE, NBM, consider activating major haemorrhage protocol, PPI cover

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18
Q

What scoring system is used in upper Gi bleeding?

A

Blatchford score

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19
Q

What is the mechanism of action of terlipressin?

A

Analogue of vasopressin - causes vasoconstriction

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20
Q

How is oesophageal varies managed?

A

Terlipressin, OGD banding or sclerotherapy

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21
Q

How are recurrences of oesophageal varies managed?

A

Beta blocker + banding

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22
Q

What are the causes of pancreatitis?

A

GET SMASHED (gallstones, ethanol, trauma, steroids, mumps/malignancy, autoimmune, scorpion sting, hypercalcaemia/hyperlipidaemia, ERCP, drugs

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23
Q

What are the features of pancreatitis?

A

Epigastric pain radiating to back - improved by sitting forward, vomiting, pyrexia, Grey Turner’s and Cullens sign.

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24
Q

How is acute pancreatitis investigated?

A

Bloods, amylase, glucose, USS (gallstones), CT abode if in doubt

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25
Q

How is acute pancreatitis managed?

A

IV fluids, NBM, analgesia, potential ERCP

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26
Q

What are complications of acute pancreatitis?

A

DIC, AKI, abscess, pseudocyst, chronic pancreatitis

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27
Q

What is the modified Glasgow criteria for severe pancreatitis?

A

PaO2 < 8, Age > 55, Neutrophilia > 15, calcium < 2 , Renal function (urea > 16, enzymes (AST > 200), albumin < 32, sugar > 10

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28
Q

What organisms should you think of if the onset of gastroenteritis is less than 6 hours?

A

TOXINS - staph aureus, bacillus cereus, clostridium perfringens

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29
Q

What are the features of S. aureus gastroenteritis?

A

Hands to dairy or meats, N&V with a leucocytosis

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30
Q

What are the features of bacillus cereus gastroenteritis?

A

Rice or sauces, rapid onset vomiting

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31
Q

What are the features of clostridium perfringens gastroenteritis?

A

Mainly contaminated meats - diarrhoea and cramps

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32
Q

What is the most common cause of gastroenteritis?

A

Campylobacter

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33
Q

What are the features of campylobacter gastroenteritis?

A

Meats and dairy, colicky pain, vomiting and bloody stools due to colonic ulceration (Rarely G.barre)

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34
Q

What are the features of salmonella gastroenteritis?

A

Often the elderly and children. Faecal-oral on meat and dairy may need antibiotics if severe (Rarely a reactive arthritis)

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35
Q

What are the features of cholera gastroenteritis?

A

Classically rice water stools – infected faecal material in water

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36
Q

What are the features of E-coli gastroenteritis?

A

ETEC – Traveller’s diarrhoea, EIEC – like shigella as invades enterocytes can produce bloody stools, EPEC – Paediatrics, EHEC – HUS.

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37
Q

What are the features of Shigella gastroenteritis?

A

Invades enterocytes and produces bloody stools

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38
Q

What is travellers diarrhoea due to?

A

Change in bowel flora due to imbalance

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39
Q

How is persistent diarrhoea and vomiting managed?

A

Oral rehydration, anti-emetics

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40
Q

How is acid released from the stomach in response to food (physiology)?

A

Lower half of stomach becomes distended so chief cells release gastrin, gastrin goes to parietal cells and stimulates proton pumps in upper two thirds of stomach to release acid

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41
Q

What receptors do parietal cells have?

A

Gastrin, Ash, histamine

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42
Q

What receptors do PPIs work on?

A

All three of parietal cells; gastrin, ACh

43
Q

How does eating affect ulcers?

A

Helps gastric ulcers, worsens duodenal

44
Q

What is the best investigation for ulcers?

A

H pylori eradication then endoscopy if it doesn’t go away

45
Q

How should ulcers be investigated if over 55?

A

Endoscopy right away

46
Q

What is absorbed in the stomach?

A

Drugs and alcohol

47
Q

What is absorbed in the jejunum and ileum?

48
Q

What is absorbed in the ileum?

A

Specialist reabsorption (eg. B12)

49
Q

What does the pancreas secrete?

A

Lipase and amylase

50
Q

What is the mode of action of NSAIDs?

A

Reduce prostaglandin formation

51
Q

How do NSAIDs affect the stomach?

A

Prostaglandins reduce acid secretion and increase mucus and bicarbonate secretion and blood flow to mucosa - -> inhibition of this leads to ulceration and bleeding

52
Q

What are the side effects of azathioprine?

A

Pancreatitis, leukopenia, hepatitis, lymphoma

53
Q

Which antiemetic is used in radiation-induced emesis?

A

Ondansetron

54
Q

Which antiemetic is used in motion-sickness?

A

Hyoscine, cyclizine

55
Q

What is cyclizine used for?

A

Motion sickness, labrynthitis and stomach irritation

56
Q

Which antiemetic is used in drug-induced vomiting and GI disorders?

A

Metoclopramide or prochlorperazine

57
Q

What are anti-motility drugs?

A

Loperemide

58
Q

What are the side effects of mesalazine?

A

Diarrhoea, idiosyncratic nephritis

59
Q

What drugs are used in H pylori eradication?

A

PPI + amox 1g BD + clarithro 250mg BD

60
Q

What is the investigation of choice in upper GI disorders?

61
Q

When should a barium swallow be used?

A

Second line after endoscopy in motility disorders

62
Q

How is achalasia managed?

A

Tear open LOS and inflate balloon at the junction or laparoscopic myotomy

63
Q

What is achalasia?

A

LOS constriction

64
Q

What is nut cracker oesophagus?

A

Oesophagus locks shut and opens rather than peristalsis

65
Q

How far can an upper GI scope reach?

A

Third part of duodenum

66
Q

What is the first line investigation for the small bowel?

A

Barium follow through/enema

67
Q

What is a small bowel MRI useful for?

A

Crohn’s - shows bowel thickening

68
Q

What is flexible sigmoidoscopy indicated for?

A

Just bright red bleeding

69
Q

What is used if colonoscopy is not available?

A

Barium enema

70
Q

What is a CT colonography used for?

A

Frail patients who can’t tolerate colonoscopy

71
Q

What is the first line investigation in acute ascending cholangitis?

72
Q

When would a liver biopsy be used?

A

AI hepatitis, or when the liver is just failing nd u don’t know why

73
Q

When is ERCP used?

A

After USS when certain it’s a bile duct issue

74
Q

What is the gold standard for diagnosis of coeliac?

75
Q

How is colonic angiodysplasia diagnosed?

A

Angiography

76
Q

How is a sigmoid volvulus diagnosed?

A

Plain film

77
Q

Which LFT will be high if hepatocytes are damaged?

78
Q

Which LFT will be high if the bile duct is damaged?

79
Q

What will raise both ALTs and Alk phos?

A

Destructive process in liver

80
Q

When is GGT raised?

A

Biliary disease, alcohol + drugs, NAFLD

81
Q

What does prothrombin time measure?

A

Shows synthetic ability of liver; PR measures coagulation, warfarin dosage, liver damage and vitamin K

82
Q

When is albumin decreased?

A

Chronic liver disease, nephrotic syndrome

83
Q

What does a decreased albumin cause?

84
Q

What causes increased AST & ALT (AST > ALT)?

A

Alcohol, cirrhosis or muscle damage

85
Q

What causes increased AST & ALT (AST < ALT)?

A

liver failure, shock, hepatitis, cancer, Wilson’s, AI hepatitis

86
Q

What does a high unconjugated bilirubin indicate?

A

hydrophobic drugs, free fatty acids

87
Q

What does a high conjugated bilirubin indicate?

A

Bile duct obstruction, gallstones, hepatitis, cirrhosis, cancer

88
Q

What is giardia lamblia?

A

Flagellated protozoa

89
Q

What are the features of giardiasis?

A

Cramps, nausea and malodorous diarrhoea 1-2 weeks later

90
Q

What is the management of giardiasis?

A

Metronidazole

91
Q

What is the management of large bowel obstruction?

A

Drip and suck, surgery if caecum > 10cm

92
Q

How is sigmoid volvulus managed?

A

Flatus tube

93
Q

What can be given for pruritus?

A

Colestyramine

94
Q

How is hepatitis A spread?

A

Faeco-oral

95
Q

How is Hep B spread?

A

Bodily fluids

96
Q

How is Hep C spread?

A

Bodily fluids

97
Q

How is Hep D spread?

A

Bodily fluids - REQUIRES HEP B INFECTION

98
Q

How is Hep E spread?

A

Faeco-oral

99
Q

How is H pylori tested for?

A

Urease breath test, stool antigens - TOC 2 weeks after eradication therapy

100
Q

What are complications in Crohn’s?

A

Stricturing, obstruction

101
Q

What antibody is positive in Crohn’s?

102
Q

What are the complications of UC?

A

Toxic megacolon, haemorrhage

103
Q

What antibody is positive in UC?

Year 1 MBChB (3 decks)

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